Summary
The Food and Drug Administration (FDA) within the Department of Health and Human Services (HHS) is responsible for oversight of medical devices sold in the United States. Regulations place devices into three classes, with class III including those with the greatest risk to patients. Unless exempt by regulation, new devices must clear FDA premarket review via either the 510(k) premarket notification process, which determines if a new device is substantially equivalent to another legally marketed device, or the more stringent premarket approval (PMA) process, which requires the manufacturer to supply evidence providing reasonable assurance that the device is safe and effective. Class III devices must generally obtain an approved PMA, but until FDA issues regulations requiring submission of PMAs, certain types of class III devices may be cleared via the 510(k) process. The FDA Amendments Act of 2007 mandated that GAO study the 510(k) process. GAO examined which premarket review process--510(k) or PMA--FDA used to review selected types of device submissions in fiscal years 2003 through 2007. GAO reviewed FDA data and regulations, and interviewed FDA officials.
In fiscal years 2003 through 2007, as part of its premarket review to determine whether devices should be permitted to be marketed in the United States, FDA: (1) reviewed 13,199 submissions for class I and II devices via the 510(k) process, clearing 11,935 (90 percent) of these submissions; (2) reviewed 342 submissions for class III devices through the 510(k) process, clearing 228 (67 percent) of these submissions; and (3) reviewed 217 original and 784 supplemental PMA submissions for class III devices and approved 78 percent and 85 percent, respectively, of these submissions. Although Congress envisioned that class III devices would be approved through the more stringent PMA process, and the Safe Medical Devices Act of 1990 required that FDA either reclassify or establish a schedule for requiring PMAs for class III device types, this process remains incomplete. GAO found that in fiscal years 2003 through 2007 FDA cleared submissions for 24 types of class III devices through the 510(k) process. As of October 2008, 4 of these device types had been reclassified to class II, but 20 device types could still be cleared through the 510(k) process. FDA officials said that the agency is committed to issuing regulations either reclassifying or requiring PMAs for the class III devices currently allowed to receive clearance for marketing via the 510(k) process, but did not provide a time frame for doing so.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.
| Director: |
Marcia G. Crosse |
| Team: |
Government Accountability Office: Health Care |
| Phone: |
(202) 512-3407 |
Recommendations for Executive Action
Recommendation: The Secretary of Health and Human Services should direct the FDA Commissioner to expeditiously take steps to issue regulations for each class III device type currently allowed to enter the market through the 510(k) process. These steps should include issuing regulations to (1) reclassify each device type into class I or class II, or requiring it to remain in class III, and (2) for those device types remaining in class III, require approval for marketing through the PMA process.
Agency Affected: Department of Health and Human Services
Status: Open
Comments: In our analysis of FDA's 510(k) submissions of class III medical devices in fiscal years 2003 through 2007, we found that, as of October 2008, 20 of the 24 device types involved in these submissions could still be cleared through the 510(k) process. On April 9, 2009, FDA required manufacturers of class III devices for which regulations requiring premarket approval (PMA) submission have not been issued to submit safety and effectiveness information to the agency so that the agency can determine if and how the classification of each device should be revised. FDA also issued a regulation (effective December 7, 2009) reclassifying to a lower class 1 of the 20 class III device types subject to 510(k) that we identified in our report. We are leaving this recommendation open because, although FDA has ordered manufacturers to submit safety and effectiveness information, the agency has not yet issued the regulations necessary to either reclassify these device types or require them to go through the PMA process. FDA officials told us that the agency remains committed to resolving the classification and premarket submission type for the remaining class III devices currently subject to 510(k). Officials also told us that the resolution of this issue was specifically identified as a fiscal year 2010 strategic priority for FDA's Center for Devices and Radiological Heath, but did not provide a specific timeline for completion of this recommendation.
